Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery
Lamberink, Herm J.; Boshuisen, Kim; Otte, Willem M.; Geleijns, Karin; Braun, K. P.J.; Feucht, M.; Gröppel, G.; Kahane, P.; Minotti, L.; Arzimanoglou, A.; Ryvlin, P.; Panagiotakaki, E.; de Bellescize, J.; Ostrowsky-Coste, K.; Hirsch, E.; Valenti, M.; Polster, T.; Sassen, R.; Hoppe, C.; Kuczaty, S.; Elger, C.; Schubert, S.; Strobl, K.; Bast, T.; Barba, C.; Guerrini, R.; Giordano, F.; Francione, S.; Caputo, D.; Boshuisen, K.; Braun, K. P.J.; Uiterwaal, C. S.P.M.; van Nieuwenhuizen, O.; Leijten, F. S.; van Rijen, P. C.; Seeck, M.; Yalnizoglu, D.; Turanli, G.; Topcu, M.; Özkara, C.; Uzan, M.; Cross, J. H.; D'Argenzio, L.; Harkness, W.; the TimeToStop Study Group
(2018) Epilepsia, volume 59, issue 3, pp. e28 - e33
(Article)
Abstract
The objective of this study was to create a clinically useful tool for individualized prediction of seizure outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. We used data from the European retrospective TimeToStop study, which included 766 children from 15 centers, to perform a proportional hazard regression analysis. The
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2 outcome measures were seizure recurrence and seizure freedom in the last year of follow-up. Prognostic factors were identified through systematic review of the literature. The strongest predictors for each outcome were selected through backward selection, after which nomograms were created. The final models included 3 to 5 factors per model. Discrimination in terms of adjusted concordance statistic was 0.68 (95% confidence interval [CI] 0.67-0.69) for predicting seizure recurrence and 0.73 (95% CI 0.72-0.75) for predicting eventual seizure freedom. An online prediction tool is provided on www.epilepsypredictiontools.info/ttswithdrawal. The presented models can improve counseling of patients and parents regarding postoperative antiepileptic drug policies, by estimating individualized risks of seizure recurrence and eventual outcome.
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Keywords: nomogram, prediction, prognosis, seizure freedom, seizure recurrence, Neurology, Clinical Neurology
ISSN: 0013-9580
Publisher: Wiley-Blackwell
Note: Funding Information: This study was funded by the Epilepsiefonds. Publisher Copyright: Wiley Periodicals, Inc. © 2018 International League Against Epilepsy
(Peer reviewed)